A coalition of Canadian physicians has released a major update to national guidelines for prescribing medications that prevent HIV infection, with a core principle of removing barriers to access. The new guidance strongly emphasizes that healthcare providers should prescribe antiretroviral drugs to anyone seeking them, without requiring patients to disclose personal risk factors.
New Data Shows Mixed Progress
This development coincides with new data from the Public Health Agency of Canada (PHAC), released on Monday. The figures indicate 1,826 new HIV diagnoses in Canada in 2024. Federal Health Minister Marjorie Michel described this as a "small decline" following several years of increasing numbers.
However, the national picture masks severe regional disparities. The data reveals that HIV diagnosis rates in Manitoba and Saskatchewan remain three to four times higher than the national average. "We know HIV remains a concern in Canada — with disproportionate impacts felt among populations experiencing health and social inequities," Michel stated in a release co-issued with the Minister of Indigenous Services.
The 2024 data represents a break from a recent upward trend, which saw over 1,450 new diagnoses in 2021, 1,800 in 2022, and 2,434 in 2023. Notably, the latest numbers do not include data from Quebec, which reported 476 new cases in 2023.
Guidelines Focus on Expanding Access to PrEP and PEP
The new clinical practice guideline, published in the Canadian Medical Association Journal, provides 31 recommendations and 10 good practice statements for prescribing antiretroviral medication both before (PrEP) and after (PEP) potential HIV exposure.
Lead author Dr. Darrell Tan, a physician-scientist at St. Michael's Hospital in Toronto, explained that 19 doctors volunteered over three years to review the latest evidence and craft the update. The range of available PrEP and PEP options has expanded significantly since the last guidance was issued in 2017.
The primary goal of these recommendations is to reverse the rise in HIV infections and help Canada meet its target of eliminating HIV as a public health threat by 2030. "We're not at all on track to reach that ambitious target," Dr. Tan admitted.
Experts Say Potential of Prevention Meds Not Yet Realized
While the 2024 dip in new cases is noted, experts caution against declaring victory. Dr. Sean Rourke, a scientist with the MAP Centre for Urban Health Solutions at St. Michael's Hospital, stated that the decrease is not statistically significant. "I think PrEP has an incredible potential, but we're not seeing the benefits of that yet," he said.
The new guidelines aim to change that by making it easier for patients to obtain these powerful preventive tools. By instructing doctors not to act as gatekeepers, the coalition hopes to increase uptake, particularly among marginalized and high-risk communities, and finally bend the curve of new infections downward.
